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    Medication to Control Your Heart's Rate and Rhythm

    WebMD Feature
    Reviewed by Jennifer Robinson, MD

    Almost everyone who is diagnosed with atrial fibrillation (AFib) ends up taking at least one type of medication.

    Doctors often prescribe blood thinners to lower the chance of having a stroke, the most dangerous complication.

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    You may also need medication to treat the irregular heartbeat of AFib, by controlling the rate or the rhythm (or both) of your heart.

    Rate Control

    "If your heart rhythm is off but the rate isn't too fast, that isn't as much of a problem," says William Whang, MD, assistant professor of clinical medicine in cardiology at Columbia University Medical Center.

    "But when the heart rate is over 100 beats per minute for very long, the bottom pumping chamber -- the ventricle -- can become weak," he says. This leads to a condition called cardiomyopathy, which puts you at greater risk for heart failure.

    The two types of medication most commonly used to slow a racing heart are:

    • Beta-blockers
    • Calcium channel blockers

    Millions of people have used these drugs for many years to treat high blood pressure and coronary artery disease. "They're very well understood, and very well tolerated," Whang says.

    Rhythm Control

    If you aren't bothered by symptoms, your doctor may decide that correcting your heart's rhythm may not be worth the side effects.

    But some people with AFib do struggle daily with fatigue, shortness of breath, and dizziness. If you do, your doctor may recommend an anti-arrhythmic medication to steady your heartbeat and help ease those symptoms.

    Some drugs slow down how fast electrical signals can travel in the heart muscle. These sodium channel blockers include flecainide (Tambocor) and propafenone (Rythmol). But people with coronary disease or any kind of heart failure can't use them, cautions John Wylie, MD, director of electrophysiology services for Massachusetts-based Caritas Christi Health Care.

    Other drugs slow nerve impulses in the heart. Potassium channel blockers include dofetilide (Tikosyn) and sotalol AF (Betapace AF). They affect the kidneys, Wylie explains, which means you can't take them if you have kidney problems.

    And while it may help fix the rhythm in the top part of your heart, dofetilide might also cause life-threatening abnormal heartbeats in the bottom part of your heart, too. You'll start taking it in the hospital. That way, doctors and nurses can watch you carefully during the first few days, when most of these complications happen.

    Most of the common anti-arrhythmic drugs work between 45% and 55% of the time, Wylie says.

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